Sinus Barotrauma: Differential Diagnosis

In 6 per cent of the ‘serious’ cases, an initial diagnosis of decompression sickness was made, with the case subsequently demonstrated to be sinus barotrauma, often with complicating sinus infection. At the time of presentation, which could be some hours after the dive, the clinical pattern was confused with cerebral decompression sickness and treated as such. These were understandable mistakes, and there should be no hesitation in administering hyperbaric therapy if there is any doubt regarding the diagnosis. It would be preferable to miss and mistreat a case of sinus barotrauma than miss and mistreat a case of cerebral decompression sickness.

The only other case of incorrect diagnosis was one subsequently attributed to a dental aetiology (barotrauma associated with pneumatization around a carious tooth), and this case was therefore not included in the series.

Lew and his colleagues18 referred not only to the symptoms of sphenoidal sinusitis, but also to its association with ‘deep sea diving’. Sphenoidal sinus involvement occurred in 6 per cent of the ‘serious’ cases. It is important because of the failure of clinicians to recognize it and to not appreciate its potentially serious complications (Case Report 8.3).

Sphenoidal sinusitis is not easy to demonstrate with plain x-ray films, but it is often obvious on MRI or CT scans.

CASE REPORT 8.3: ID was not part of the ‘serious’ case series, but he sustained clinically obvious sphenoidal sinus barotrauma of descent. This caused some concern because of the proximity to other important structures around this sinus and the possibility that the computed tomographically verified space-occupying lesion was neoplastic. Although operative intervention was contemplated in this case, the lesion (a mucocele or haematoma) cleared up within 2 weeks, following abstinence from diving.